Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I am delighted to have an opportunity to speak on this very important legislation. I hope it serves the purposes for which it is intended. I hope it will improve the standard of care and attention available to all of our constituents throughout the country, that it will safeguard hospital staff themselves and protect them so that mistakes that might be made and things might have been overlooked will not be overlooked in future, and that the quality of services provided will be acknowledged and universally applied, without exception.

I am a Member of the House and I was a member of a health board and hospital visiting committees. Over the years, we have all seen incidents that could have been prevented. We have also seen very expensive cases that end up in court where it is alleged, and proved in some cases but not in others, that something went wrong and a mistake was made.

It is important that a mistake is acknowledged, but that does not always address the impact of the mistake on the victim, in particular where a victim has died. As I said, this is important legislation. It is important to acknowledge that one can err but in these circumstances the error can be serious and have long-lasting or permanent consequences for the victim.

Reference was made to accident and emergency departments throughout the country. I agree that they are not operating satisfactorily and are not sufficient to meet market requirements. The population of Ireland has increased by 500,000 over the past ten years, be that through immigration or emigration. All of these people require services of one kind or another and, thus, there is an additional burden on the system. Demand has increased and our health service is demand-led. It is unacceptable to say that demand was anticipated to be X, Y or Z at a particular time of the year but that, unfortunately, it turned out to be greater than anticipated. We must properly anticipate demand. We have no choice but to do so. As I said, our service is demand-led and, as such, we have to make provision for it.

At a meeting of the Joint Committee on Health earlier this week, I made the point that it is incumbent upon us when identifying the budget for the health services to also predict what contingency might be required. We know that a contingency will be required so we make provision for it. If the contingency is not spent it can be carried forward to a subsequent year to the benefit of patients and the quality of their treatment. It is distressing for patients admitted to hospital to be on hospital trolleys for lengthy periods. Obviously, patients who are admitted are unwell. A person who is fit and waiting for minor medical attention in an emergency department for a long time will find the experience extremely boring, annoying and distressing but for the person who is ill, the experience is ten times worse.

In terms of recovery, the health service still has a way to go. I do not apportion blame for this to any particular Minister. I deal with opposition in committee as it arises, and I do so on a fairly regular basis. It must be recognised that there are some things we cannot do without advance monetary provision. Whether we do so, however, is up to us. There is a hue and cry when it comes to over-expenditure. The modern way is to criticise over-expenditure and so on. That is unfair. There is no need for over-expenditure if the level and extent of funding required for the service throughout the year is properly identified. This is how expenditure was managed previously. It is only in recent years that the sticking plaster came on stream. It is a bit like a footballer clearing a ball that is about to go into the net into the feet of an incoming forward who buries it in the back of the net. Nowadays it is an emergency reaction all of the time, which does not make for good, quality services.

At a meeting earlier this week, we heard about constant queues and confusion in waiting areas in a number of hospitals. There are beds available, adjacent to and within those hospitals. In some cases, there are wards that have been closed and beds decommissioned. This should not be tolerated at a time when patients are waiting lengthy periods for treatment. By way of example, a child with autism, who is volatile and whose reaction can be sudden, injured himself during a breakdown and was taken to the local emergency department. One does not have to be a medical professional to know that the child required immediate medical attention but despite having waited some time in a very crowded area, he was left untreated and the parents took him home and returned the following day, when they again had to wait for a lengthy period to have him seen. This is the daftest situation I have ever come across. There is no excuse for it. Service providers operating at the coalface and presented with such a situation must have the means to deal with it properly, effectively and efficiently to the satisfaction of the patient. In the case of a patient who has a condition that renders him or her incapable of understanding what is happening, we have a special responsibility. As politicians we need to ensure that such cases are dealt with not when people have time but immediately. We need to ensure that provision is sufficient to ensure that when such cases arrive at emergency departments they are dealt with immediately.

I hope that this legislation will have an impact on the way in which we deal with those cases and that it will enhance and give prestige to our health service. We have some of the best medical professionals in the world in this country but we do not appear to be able to retain them. The more we criticise the service, the worse it gets. When staff are demoralised they question being asked to perform tasks for which they do not have the resources. It is easy for the system to blame others. It needs to look inwards and determine what is required in monetary terms to do the job. In regard to the overcrowding in our emergency departments countrywide, perhaps a troubleshooter should be appointed to identify and investigate the bottlenecks and logjams in terms of throughput of patients, the cause of the slowdown in the system and how it can be addressed. It is possible to do all of this, but it is not being done. There is passive acceptance of an inferior service which is threatening patient safety.

In regard to mental health patients, there is need for an awakening to their plight and for them to be attended to efficiently as they may not always understand what is happening to them.

In some cases it may be their first experience or they may have had many experiences. If we do not do something about it, then the good name of the hospital, the institution, the GP or whatever it is, is in danger of being damaged.

Many medical professionals from all over the world are willing to come here if we want them but we will have to pay a price. We do not have to pay New York prices every time. There are those who say that we do but that is not necessarily the case.

We have to be inventive in the way we deal with the throughput. This has to be done quickly and safely.

The other issue, which is main purpose of this Bill, is to admit our mistakes and to make a decision. We often hear of a case being settled without acceptance of liability. That may well be the case. It is very easy for me to criticise a medical professional in a crisis moment and to say it should not have happened. We know it should not happen but whether my criticism will solve the problem remains to be seen. What I do know is that insofar as we can, we have to be open with the public. When we know that something has gone wrong, we have to be willing to say we are sorry, this did happen and should not have happened, and we admit it. Failure to admit in those circumstances only drags on and multiplies the legal costs many times. That should not be allowed to happen because it is not in the interests of the services, the institutions involved, or in the interests of our staff.

We have a lot to do in this particular area but we can do it if we apply ourselves to it.

I will also mention the alacrity with which it is generally accepted, in Murphy's law, that if it can go wrong it will go wrong. It does not have to be that way, as long as we were absolutely certain that we have done the best we can and have put in place, as best we can, the necessary resources to deal with the situation. That also eliminates from the whole scenario the fact of there being mitigating factors, what they were, and was it because we did not have resources. There should never be an accident or incident in a hospital where the resources were inadequate. We cannot provide a health service on that basis. We have to provide a health service that is reliable, that protects people's health, the public, the institutions and the State, all of which have a common interest in this particular situation.

I am aware of situations in the past where patients have not been given the information or where the relatives and family have not been given the information and where they had to fight for it. That should not be the case any more than the CervicalCheck system should not have been the way it was. I am aware there were mitigating factors, in that it was not a diagnostic system but was a system that had a 70% to 80% accuracy rating. It was held afterwards in court that women should have been told at an earlier stage and if they had been told at an earlier stage, there might have been the possibility of a different outcome. This is always very hard to determine but it is not very helpful to the patients and their families. It is not very helpful if there is a doubt about it. It is the doubt that undermines the integrity of the system. That doubt should not be there. It is important for us all remember that we can criticise those working in that system as much as we like, but if the system itself has only a 70% to 80% accuracy rating, then we need to acknowledge that from the outset. We must recognise that it is not a gold standard and was never going to be one. The presumption that it was a gold standard is wrong. It may be convenient for us at a given time to say that X, Y and Z took place and should not have taken place. We know that things happened that should not have happened. The system, however, was in operation for quite a while. The Minister, the staff, and the clinics have been blamed. This has happened, however, with the benefit of hindsight. Remember, the system has been in operation for several years and without a doubt identified and averted the deaths of hundreds of women. The issues involved were identified long beforehand in order to be able to take corrective action. This could only be done with a 70% to 80% accuracy rating. That does not change. It could be 90% one day in one group of patients, depending on their particular state and the degree to which their system was coping with what was an onslaught. The incidence of cancer-creating conditions might never be detected and there have also been situations where that has happened.

All of a sudden, we became 100% accurate, and on that basis everybody is condemned. I am fully aware of the fact that people who worked in that system became extraordinarily frustrated because no matter what they did, they could not do anything right. Day after day, something else popped out of the woodwork to prove that they were wrong again. As long as we go down that self-righteous road in the health services in the determination of what is right and what is wrong, we always will have that problem. Misdiagnosis is one thing but a system that has only a 75% to 80% accuracy rating is a totally different thing. It is not a firm diagnosis at all. As a result, we need to be cautious about who we blame and how we blame them.

We must also acknowledge the benefits accruing to the health of the women of the country from that system, even though there were some tragic oversights leading to loss of life and serious illness that did occur and perhaps should not have occurred. Hopefully, the revised system will address that to a far greater extent and we will not have to revisit this.

In the short time remaining to me, I will mention another matter. We all deal with cases of emergencies, and for some unknown reason, the public believes that we have a responsibility in the matter and should respond to some things from time to time about which people are not getting a resolution from the system. We should do this and be doing that on a fairly regular basis. In order to keep in touch with the issues that affect those who are patients, medical professionals, coming through the system, or whatever, we need to be regularly involved. It is only then that we will know what we are talking about.

We will learn, as time goes by. The one question that is put again and again to politicians is whether they are medical professionals, having expounded on a theory with which somebody may disagree. My response to that question is that I am not, but that I do not have to be to be able, within reason, to identify something obvious, as any human being can. I may say there is something wrong with that unfortunate person and we need to do something about him or her. If something is not done and something goes wrong, it will be asked of me why I did not do something about it and did not respond. I will be asked why did I not stand up and take my responsibilities seriously. Incidentally, I am not touting for business, but in 90% of the cases of that nature that I have dealt with, I was right.

There is a need to be vigilant at all times. I am not criticising the medical profession or any of the other professions but it must be always remembered that when a member of the public, a patient in these circumstances, feels that something is wrong, they usually know. The response will depend on the way they describe it and hopefully, if the member of the public describes it well and we respond to that, then something can be done about it.

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